tv Today in Washington CSPAN January 15, 2010 2:00am-6:00am EST
are you there, janell? [applause] [applause] speaking of being mayor for those who need it, this three young women who sang for us earlier are due to our investment at the washington youth academy. the academy is proving second chances work and turning around the lives of at risk kids who have nowhere else to turn.
"new york times" -- this is about the different versions in the house and senate versions over insurance exchanges. here to talk about that is linda blumberg from the urban institute. she is a senior health policy fellow. she has her ph.d. in health care. what is the basic concept of in exchange, and what is the difference between a state-run and federally-run? guest: the health insurance exchange is a government entity that creates an organized help enter the marketplace. it is focused largely in pieces of legislation involving purchasers and those who would be purchasing through small groups. it does not bear risk itself, it contracts with insurers to provide the coverage. its intention is to ensure that
they are complying with consumer protections, that it is fostering cost-efficient, good competition among health insurers, and is helping people and all and expand health- insurance coverage to those who do not have it today. host: most states have health insurance commissioners whose job it is to oversee the insurance providers. what is the difference? guest: insurance regulators do not play a role in helping people get coverage. they do not provide as much oversight, frankly, for the consumer protections, as we would like to see. right now we are creating a system where we will facilitate health insurance competition, which is lacking in the best majority of markets today. the exchange is a way to organize the market, held it
function better, and assist people to get coverage, which injured commissioners do not do today. host: no. any states that are currently running successful the changes? guest: yes, massachusetts has done a good job. the uninsured rate in the state is below 3%, analyst in the country. host: how did they do it? just go through a variety of tools. they have this thing called a connector, basically, an organization to help with coverage. it provides subsidies for health insurance coverage to those up to 300% of the poverty level. all low-income adults and children have subsidized health insurance coverage there. and they provided different insurance regulations to help make sure risk was being spread broadly, that the sec -- sick
were not being discriminated against. host: we would love to hear from you, particularly you in massachusetts. it looks like the debate will be if legislation should be at the state or federal level. is that correct? guest: senate is the state, house is federal. host: they were the ones most interested in the public option. this is one way to help those people who wanted that. guest: you could still have a public option if it was state- based. massachusetts does not have that right now. host: the phone numbers are on the screen.
massachusetts, let us talk specifically at what has happened to health care costs. guest: their health-care costs are growing basically at the same rate that they had been prior to reforms. so what they are doing is spending more government dollars as they move from federal interstate dollars to provide coverage for people who did not have it before, but in terms of the cost-containment concern, that is the biggest issue. while they have done the expansion and it has not created a worst cost situation, they are struggling with to do now in the second phase in terms of slowing the rate of health care spending, which is an issue we face all over the country, not just massachusetts. host: what should be the issue as congress looks at this cost side?
coverage. host: could you explain the difference in how they federal plan would be structured, compared to a state plan? guest: it is a manner of who will be overseeing these exchanges. either it will be the federal government or individual states. under the senate version, which is state-oriented, they could opt out, or if they demonstrate they are not able, the government could step in. on house side, the opposite could happen. in individual state such as massachusetts who had it up and running code apply to run it on their own and get approval. so there are some outlets on both sides for the opposite to
occur but the key is how much uniformity there will be across states in the types of plants people are for dissipating in, which plans are in, which are out, how the information is collected and dispersed to consumers. host: the house has a suite of plans to choose from. guest: the federal employee health benefit plan has a flavor of the help change to it. it is still employer-based, so it operates differently. the only people who can obtain coverage through the federal plan a party their people working actively for the government, or are retirees. it is different because they do not have to worry about enrolling uninsured people.
the notion that you have a suite of plans, and someone is giving you information, which is great, compared to what other employers to, it does help consumers compare their options and figure out what is best for them. so there are some similarities, but the connector would go quite a bit further. host: does the urban institute have a position? guest: we did not take issues. we are a nonprofit organization. we are about information, not advocacy. host: chris in michigan. on the republican line. caller: i have a couple of
questions. i have family in massachusetts. i have sold health insurance and private markets before, so i am familiar with what is happening there. i am in michigan and i am unemployed, so i understand a range of these issues. my question with exchanges has to do with two things. it assumes people are not capable of making choices and understanding health insurance on their own. i have a variety of companies i can choose from for private insurance, but the cost of that insurance is still prohibitive. if you add exchange, it seems to me that will increase costs and would put the government in control of private health insurance companies. massachusetts is twice as expensive as any policy and i can buy in michigan with equal coverage.
can i do not see how the hell the exchange lowers cost for makes it easier for me to have insurance. guest: you raise a number of points. the issue of the information is a big one in health insurance right now. particularly, in the non-group insurance market, those people who have to buy in on their own. there are a number of options out there but there is also an enormous lack of information. it is typical for companies not to provide documentation of that policy until someone is enrolled so people do not have full information of what they're getting. they do not have all lot of information -- a lot of information about what their cost sharing will be, services.
people will get little information ahead of time in terms of what drugs are in the formularies, which doctors will participate, etc. to help it turns exchange could provide uniform information to make sure that someone is buying something that they understand. it does not mean that there will be fewer options available to people, especially because it will be costly for people to apply for health insurance coverage on their own. they often have to pay a fee just to go through the application process. so there would be changes in terms of the uniformity and completeness of information. in terms of cost, individual health insurance is the most expensive way to buy coverage. it is the option of last resort. the administrative costs, as a
share of what the benefits are that are paid out can be 30% to 40%, so this is an expensive way to buy coverage. so expanding the group, centralizing marketing, facilitating in moments of the individuals have an easier time getting in, could hold down those costs. also, the more information you give people and allow them to compare plans easily, the more incentive you are giving interest to be cost efficient. if you compare, that is what creates competition. host:es port. -- shreveport. lonnie on the republican line. caller: thank you for taking my call.
the so-called reduction in medicare -- is this information or misinformation? are they really going to reduce the amount of money in medicare to pay for this plan? also, the public option. how come they do not want to fight for that? it seems to me that it would be a good way to go. if people are insuring -- purchasing insurance, they are responsible for reading the policy and numbing their coverage. it is just like taking out a loan. if you sign on the dotted line,
you are responsible because it is a contract. i think republicans are just fear-mongering, trying to kill the bill simply because of the input of lobbyists. host: thank you for the call. guest: public comment on the medicare question. the pieces in the legislation that would reduce cost under medicare are comprised of a number of components that have been discussed by legislative advisory commissions in the past, such as the medicare advisory council, which advises congress on issues of payment in medicare. issues have also been raised by the congressional budget office. these are pieces of the medicare puzzle that have been pretty frequently discussed in places
where there are overpayments in the certain -- current system. regardless of reform, these have been savings which many experts feel should be put in place anyway. so what has been going on is this notion that we have this large expansion of health insurance coverage, there are costs associated with that. let us put in place could print -- good business practices for the medicare program and use those savings to directly finance health care reform. my expectation, in the current budget deficit environment, if we did not have reform, these components would be put in place anyway for deficit reduction. here we are using it for financing health care reform. they are not things that will -- medicare beneficiaries will feel just as adversely affected. this has been one of the most
controversial components of the legislation. with regard to what we believe would be the impact of having a public option -- a strong public option available in the health insurance exchange, is one that would basically catalog their competition. it would be there as a lower administrative costs and a somewhat lower payment rate-type of plan available. because of its presence, it would force other insurers to negotiate with providers in a more aggressive way. right now we have a lot of concentration in health insurance market, but we also have a concentration in the hospital markets. this has created a situation where there is not a lot of incentive for in jurors to lower the rates -- insurers to lower the rate the our pain
thethey are paying. host: next phone call. caller: i have a couple of questions. i am on medicare and medicaid. under the current bill, would i be required to purchase insurance? my second question is, what are people not looking harder into why the's health care system? even rush limbaugh has praised it as the best health-care system in the world. -- hawaii's health care system? i understand it is a social system and he seems to praise it as the best in the world. i am sure he is angering the gop world. guest: those individuals that are dual eligible would feel
little difference, if any, under the reforms. as far as individual mandates to have health insurance coverage, it would apply to those non- elderly individuals who are over the poverty threshold. in terms of medicare and medicaid coverage, that would certainly qualify as acceptable coverage. so the world should stay pretty much the same. hawaii is an interesting state. it is a state that does not have a government system, although that is a misunderstanding. what they have is different from other states. they have some requirements by their employers to purchase health insurance for their workers. there are a lot of exemptions, so there are a lot of people who do not have employer-based
insurance, but that is why they have somewhat more coverage compared to other states. however, they do not have an extensive system to provide financial support to the low- income population beyond medicaid. so they could use a lot of help, and would get a lot of assistance from this reform in terms of providing for their low income population. host: this is a question that house and senate negotiators are facing. a national market for insurance or one in every state? in the "new york times" -- what would that do? guest: i think that would create complexity. what we do not want is people be eligible for more than one exchange. what that does is create more
administrative costs. it also sets up a situation where there could be competition between federal and state exchanges for the healthiest individuals which then creates a problem where we have to worry about whether or not people who have higher costs will be affordable. so it creates an extra layer of bureaucracy and complexity that i think would be an error. let me read from one accot yesterday --
back to your phone calls as we talk about health insurance exchanges. tallahassee, clinton on the republican line. caller: i had some concerns about the nature of the debate. my concerns were two fold. it seems strange to put these burdens on the states. medical providers seemed to dwindle and of course, more people will be in need. some people, unfortunately -- there is a stigma associated with medicaid. some people also know that if you have medicare, it is harder
for primary care providers to find a provider for medicare. it would seem that had the specter of the stigma is growing taller, whether they are eligible due to circumstances, seemed to becoming second-class citizens, and this is slipping away from the debate. i could go on for quite some time about this, but i wonder if anyone will address these issues of the dwindling pool of primary care providers and the stigma that some of these existing plants are getting, not to mention the stigma of the public plan. where are these providers going to come from with the ever-
increasing cost? i will be happy to take my comments off the air. guest: with regard to state medicaid and cost, all those would be made newly eligible for the program through the reform. they would be enrolled in the states, but states would receive very high matching rates. so the government would be internalizing the vast majority of the cost associated with those newly-eligible individuals coming into the medicaid program. .
once the culture of the community changes in terms of the notion that there is an expectation that people will have health insurance coverage and there is some community responsibility involvement in ensuring that happening -- that is happening, that eases that stigma. i think with a great deal more outreach and facilitation and making it easier for people to get enrolled in these programs, it will improve quite a bit. provider supply is an issue and i think it will be a continuing
one. the house legislation does include some additional funds increasing some payment rates in the medicaid program. whether that will exist in the senate, we do not know. i think it will occur for some of the reasons you are loading to, and with regard to the differentials between payments to physicians between medicaid and under medicare, because medicaid generally pays quite a bit less than medicare to providers, i think that would be one that continues over time and it will become closer to medicare levels. host: assuming a deal is reached between negotiators and legislation returns to the floor, it is a question of how it gets to a vote. cnn news is asking white house spokesman robert gibbs about
system. lots of different pieces that work differently for different populations, that if you are trying to improve the situation for many people and at the same time preserving the peace is that people like, which is what they're trying to do here, then it creates a veryion. we have these very large bills that are difficult to get host:ñi mississippi, democrats line. caller:çó good morning, i've ben listening to c-span -- i watched the whole health care debate from gavel-to-gavel. i was very hopeful by what the outcome was. then i watched my spirits think as i watched what happened to it in the senate. right away that sounded exactly to me like that massachusetts bill, which i had heard about a long time ago -- which i knew was mitt romney cosy dea's deal.
it came to mind what gore vidal said, he said, you have two conservative parties in this country and one is just as conservative than the other one. the thing about with the romney plan is that, like any state that has auto insurance -- or you require auto insurance in iowa, we just had that happen to was about three or four years ago. the auto insurance premiums went up 30%. it was exactly the opposite of what they claimed would happen. i like the way this woman talks about all this health care and everything because she seems so thorough. and she has mentioned the massachusetts plan a couple of times. what i do not get is, once you have an external -- an insurance
exchange, but it is still a mandate -- you are still going to have the mandate. the insurance companies in the exchange, would inspire them to lower their costs? i do not get it at all. it still seems like a two party system, but one less conservative. it is like we are spoon feeding customers to the insurance companies. guest: i will try to respond to the issues of your concern, about cost containment and what the incentives are. the situation with the exchanges -- actually, let's take a step back and talk about today for a moment. right now, there is not a lot of incentive for cost containment in the private health insurance system. nor in the provider systems. the way things are structured nowñi, there is a lack of availability for customers to
bargain with providers of their fees and pass the savings on to the consumers. the idea for the exchange is not one to have the government set rates, which is what made you are alluding to with a more government-oriented system. cost containment is a bit more straightforward where the government would set the rate and provide -- and decide what the providers would be paid and cool down the rate of spending that way. what is going on here is trying to create an environment that is less politically controversial than that kind of approach where you set up a marketplace that would function better than the markets where -- that we have now, where the incentives are not for the insurers to save money by avoiding those who have high medical needs, the sick, and trying to attract the healthiest groups and individuals, but instead, were this risk is spread very broadly
for these populations. but to do that you have to have these requirements of coverage so that individuals who are healthy cannot opt out of the system and not sharing the costs associated with people who are sick. as we all know, everybody ages and everyone has episodes of bad health. to have everybody in, whether sick or healthy, means that everyone is protected later on down the road whether they are sick or healthy. these pieces -- bringing a structured marketplace together and then putting information in place, putting rules in place to encourage the health insurers to compete at providing cost efficient care instead of avoiding high cost individuals. that is the idea. host: mike allen in his political rupp this morning looks atñr the media and says ia front-page "los angelesñr times"
story -- the idea discussed wednesday in a meeting at the white house could placate those who bitterly opposed -- bitterly oppose president obama's high tax insurance coverage that would affect many union members. what has your experience been in massachusetts with your exchange? caller: i'm a diabeticçó and i'm on social security. i fortunately get my health insurance through my wife. i noticed with our insurance here, our rates keep going up. i went to see my kidney
specialist is today and i asked him what his opinion was on the health care bill coming up and he told me about -- if he had about two hours, he could tell me. apparently, he is not in favor of that. up here, -- ok, we did on after keiko pay on our tests. like i said, my wife is still working, and she has had lesions on her brain. those tests are usually covered, and now all of a sudden, it is a $50 per pay period -- $50 copay. i've got to tell you that up here in massachusetts, we pay quite a bit. if you do not have a number from the insurance company when you
way because cost containment means taking money out of somebody's pocket, very much so out of hospitals, physicians, and potentially the insurers. what we have is a lot of political force working against cost containment, but then a lot of real perception and understanding of the need for it in terms of helping the system move forward and keeping coverage affordable. one of the things that would be included in the legislation here for those that would be eligible for coverage through the exchanges, in addition to subsidies to help people by premiums and make sure that the coverage is affordable in that respect, there would also be some out of pocket financial and stick --óú financial assistance for the low-income population. it would have limits on how much of pockets -- out of pocket
could be applied to individuals when they get sick. there would be some assistance in this legislation for that. host: camden, republican line. caller: from all indications and everything i've heard, this government takeover is still only going to cover 95% to 96% of people. but we will still have many that are not going to be covered. and the insurance that is going to be offered is going to have such huge deductibles and co- payments that people are going drop to think twice about going to the hospital and doctor and they are still going to declare bankruptcy because -- when they cannot pay them. and if you pay a penalty or a tax because you choose not to buy insurance, when you go to the emergency room or if you
have a catastrophic illness, it is still not going to be covered. the situation will remain the same. and you talk about administrative costs, when you enter the government into the administrative costs, we're talking billions of dollars. the president said he would reduce costs. let's throw out this health care bill and get something worked out before it is crammed down our throat. how are they going to reduce cost? that is what we need to know. the insurance companies only have a 3% profit margin. the media has the biggest profit margin, as well as the fed and wall street. these things need to be written in stone before weekends -- so that we can see them before this is crammed down our throat. our going to keep people from going bankrupt because of huge deductibles and co pay?
what are you going to do with the panelists asians for people through taxes and people are still going to get sick? guest: there are a lot of issues that you raised there. i will try to touch on what i can. in terms of there not been complete coverage in these health care bills, that is correct. there would be roughly 5% of the population that is expected to remain uninsured. a significant a part of that population would be individuals who are here from other countries and do not have legal status to be here. that was a very significant political issue and members of congress felt strongly that there was not public support for providing financial assistance to individuals who were not here legally. as a consequence, there is a population that will remain
uninsured and it will be a significant issue as it is today, in states where there is high immigrant populations such as california, texas, florida. some of elements of assistance to those states will be necessary. other individuals who will not pick up coverage voluntarily will be eligible for public coverage through medicaid so that if they become ill or injured and they go to a hospital, they can get enrolled at that point. but there will be others who remain outside. as far as the out-of-pocket costs go, the relatively high deductible plans that would be offered within the health insurance exchange and would be the minimum amount of coverage that people would be required to have -- however, that does not keep them from getting comprehensive coverage as many people do today, that would also
be for those in the exchange of modest income and an eligible for financial assistance. they would get not only premium assistance, but also required to payçó lower out-of-pocket costs. they would have cost sharing subsidies as well. there is a good deal of assistance, but insurance -- in terms of making sure everyone has very low pocket liability across the board, while that is a very nice idea and a lot of people supported, it also costs more in government dollars. -- a lot of people support it, it also costs more in government dollars. ñrand they're trying to moderate ñibetween those concerns. host: springfield, missouri, you are a last question on this topic. caller: on insurance exchanges, change would be much more cost-
effective and efficient and other than state plans. with respect to automobile insurance, the state has -- the state assigned risk pools have been quite effective. çóa few comments on things thate hear -- if i could buy insurance across state lines -- every insurance company rights in the states that they choose. but they choose a produced eight, that is where they do business -- if they choose a particular state, that is where they do business. with respect to this current health care plan -- i know it has been destroyed as it has gone through congress -- i
personally think it is a mistake to enact the current plan. there is nothing in there to control costs. the only thing that will control costs is competition and there is no competition. the cost of current health care is created by people and it is also created by providers. an example on providers, i've wanted to change my primary position -- i wanted to change my primary physician to another location, and the only medication ayman is 5 milligrams of alpace a day. a couple of days later i got a call from the nurse and they said he wanted to see me in a month. i said, why? and they said, well, you take
blood pressure medication and he wants to check your blood pressure. it turns out that if i did on a creek -- unless i agreed to go to his office once a month to have my bloodñi pressure taken, which there was no where was going to do, he would not accept me as evasion. host: -- accept me as a patient. host: that is obviously an example of cost containment. guest: they have some of us -- some liability if they are not monitoring you properly while you are on medication. i cannot compliment -- comment on the appropriateness of that. the position may feel that is a corporate care. in terms of the state vs. -- the physician may feel that is appropriate care. in terms of the state vs. medical exchanges, the first is one of uniformity in terms of access to coverage that is
comparable across the state. we do have some concerns that the more variation you allow, the more flexibility that states have, you may end up with people -- very similar people in two somdifferent states have ben very different access in terms of coverage of is available to them. the second concern is one of federal dollars. this reform is largely spending federal dollars. not state dollars. and so, when you have the federal government not administering the health insurance exchanges, not doing the oversight of how the markets are working and how the money is being spent on insurance plans as director, then you have a situation where somebody who is doing oversight is not really the one hand the on money and there is a bit of disconnect in terms of incentives for